Provider Demographics
NPI:1003302696
Name:BRANDON, KIMBERLY HOPE
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:HOPE
Last Name:BRANDON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1011 DELRAY ST
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-1241
Mailing Address - Country:US
Mailing Address - Phone:919-423-2310
Mailing Address - Fax:
Practice Address - Street 1:6516 FALLS OF NEUSE RD STE 110
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-6847
Practice Address - Country:US
Practice Address - Phone:919-423-2310
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-06
Last Update Date:2018-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health